Variable Compression Surgical Fastener Cartridge

ABSTRACT

A surgical fastener applying apparatus having a first jaw and a second jaw. The first jaw includes a cartridge body having plurality of surgical fasteners disposed therein. The plurality of surgical fasteners include a plurality of first surgical fasteners having a first backspan with a first configuration, and a plurality of second surgical fasteners having a second backspan with a second, different configuration such that the plurality of first surgical fasteners apply a first compressive force to tissue upon formation and the plurality of second surgical fasteners apply a second, different compressive force to tissue upon formation.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.13/571,311, filed on Aug. 9, 2012, which is a continuation of U.S.patent application Ser. No. 13/069,602, filed on Mar. 23, 2011, now U.S.Pat. No. 8,424,735, which is a continuation of U.S. patent applicationSer. No. 12/417,685, filed on Apr. 3, 2009, now U.S. Pat. No. 7,926,691,which claims the benefit of, and priority to, U.S. Provisional PatentApplication Ser. Nos. 61/044,656 and 61/044,696, each of which was filedon Apr. 14, 2008, and is now expired, the entire content of each of theapplications identified above being incorporated by reference herein.

BACKGROUND

1. Technical Field

The present disclosure relates to surgical fastener applying apparatus.More particularly, the present disclosure relates to surgical fastenerapplying apparatus that include surgical fasteners that are configuredto apply varying compressive forces in tissue.

2. Background of the Related Art

Many varieties of surgical fastener applying apparatus are known in theart, some of which are specifically adapted for use in various surgicalprocedures including, but not limited to, end-to-end anastomosis,circular end-to-end anastomosis, open gastrointestinal anastomosis,endoscopic gastrointestinal anastomosis, and transverse anastomosis.Suitable examples of apparatus which may be used during the course ofthese procedures can be seen in U.S. Pat. Nos. 5,915,616; 6,202,914;5,865,361; and 5,964,394.

In general, a surgical fastener applying apparatus will include an anvilthat is approximated relative to a surgical fastener cartridge duringuse or a fastener cartridge that is approximated relative to an anvil.The anvil includes depressions that are aligned with, and/or are inregistration with slots defined in the surgical fastener cartridge,through which the fasteners will emerge. To effectuate formation, thefasteners emerge from the surgical fastener cartridge and are drivenagainst the anvil. The surgical fastener cartridge typically has one ormore rows of fasteners disposed laterally outward of a channel or knifeslot that is configured to accommodate a knife, or other such cuttingelement, such that tissue can be simultaneously severed and joinedtogether. Depending upon the particular surgical fastener applyingapparatus, the rows of fasteners may be arranged in a linear,non-linear, e.g. circular, semi-circular, arcuate, or otherconfiguration.

Various types of surgical fasteners are well known in the art including,but not limited to, unitary fasteners and two-part fasteners. Unitaryfasteners generally include a pair of legs that are adapted to penetratetissue and connected by a backspan from which they extend. In use,subsequent to formation, certain types of unitary fasteners have a “B”shaped configuration. Typically, the two-part fastener includes legsthat are barbed and connected by a backspan. The legs are engaged andlocked into a separate retainer piece that is usually located in theanvil. In use, the two-part fastener is pressed into the tissue so thatthe barbs penetrate the tissue and emerge from the other side where theyare then locked into the retainer piece.

During each of the aforementioned surgical procedures, the tissue isinitially gripped or clamped between the cartridge and anvil such thatindividual fasteners can be ejected from the cartridge, through theslots, and forced through the gripped tissue. Thereafter, the fastenersare formed by driving them into the depressions formed on the anvil.

A common concern in each of the procedures mentioned above ishemostasis, or the rate at which bleeding of the target tissue isstopped. It is commonly known that by increasing the amount of pressureapplied to a wound, the flow of blood can be limited, thereby decreasingthe time necessary to achieve hemostasis. To this end, conventionalsurgical fastener applying apparatus generally apply two or more rows offasteners about the cut-line to compress the surrounding tissue in aneffort to stop any bleeding and to join the cut tissue together. Each ofthe fasteners will generally apply a compressive force to the tissuesufficient to effectuate hemostasis. However, applying too much pressurecan result in a needless reduction in blood flow to the tissuesurrounding the cut-line, resulting in an elevated level of necrosis, aslower rate of healing, and/or a greater recovery period.

Consequently, it would be advantageous to provide a surgical fastenerapplying apparatus capable of limiting the flow of blood in the tissueimmediately adjacent the cut-line to effectuate hemostasis and woundclosure, while maximizing blood flow in the surrounding tissue tofacilitate healing.

Additionally, when tissue is clamped and compressed between the anviland the surgical fastener cartridge, some of the fluid of the tissue issqueezed out so the tissue is compressed further at the center portionsof the cartridge and anvil than at the lateral edges, thereby leavingthicker tissue at the edges. It would therefore be advantageous toprovide surgical fasteners which could better accommodate theseresulting different tissue thicknesses.

SUMMARY

In one aspect of the present disclosure, a surgical fastener applyingapparatus is disclosed having a first jaw and a second jaw. The firstjaw includes a cartridge body having plurality of surgical fastenersdisposed therein. The plurality of surgical fasteners include aplurality of first surgical fasteners having a first backspan with afirst configuration, and a plurality of second surgical fasteners havinga second backspan with a second, different configuration such that theplurality of first surgical fasteners apply a first compressive force totissue upon formation and the plurality of second surgical fastenersapply a second, different compressive force to tissue upon formation.

In one embodiment, the first surgical fasteners are arranged in a firstrow and the second surgical fasteners are arranged in a second rowlaterally outward of the first row wherein the first and secondbackspans are configured and dimensioned such that the first compressiveforce is greater than the second compressive force, whereby blood flowthrough tissue surrounding the plurality first surgical fasteners afterformation is less than blood flow through tissue surrounding theplurality of second surgical fasteners after formation.

In some embodiments, each surgical fastener in the plurality of surgicalfasteners defines a substantially equivalent overall height when formedin the tissue.

In one embodiment, the first configuration of the first backspan of theplurality of first surgical fasteners include a twisted configurationdefining a first height, and the second configuration of the secondbackspan of the plurality of second surgical fasteners include abackspan having a twisted configuration defining a second height lessthan the first height.

The cartridge body may include a channel that is configured toaccommodate a cutting member for the creation of a cut-line in thepatient's tissue. When the plurality of surgical fasteners are arrangedwithin the cartridge body, the plurality of first surgical fasteners maybe arranged to define a pair of first rows disposed laterally outwardlyof the channel, and the second surgical fasteners may be arranged todefine a pair of second rows disposed laterally outwardly of the pair offirst rows.

In some embodiments, the plurality of surgical fasteners loaded into thecartridge body may further include a plurality of third surgicalfasteners each with a third backspan having a third configuration thatis different than at least one, and preferably both, of the respectivefirst and second configurations of the first and second backspans. Thethird fasteners can be arranged in a third pair of rows laterallyoutward of the pair of second rows.

The third fasteners may be configured and dimensioned to apply a thirdcompressive force to the tissue upon formation of the plurality of thirdsurgical fasteners that is different than at least one, and preferablyboth, of the respective first and second compressive forces applied tothe tissue by the first and second backspans upon formation of theplurality of first surgical fasteners and the plurality of secondsurgical fasteners. Preferably, the first compressive force is greaterthan the third compressive force, whereby blood flow through the tissuesurrounding the plurality of first surgical fasteners after formation isless than blood flow through the tissue surrounding the plurality ofthird surgical fasteners after formation. Preferably, the third backspanis configured and dimensioned such that the second compressive force isgreater than the third compressive force, whereby blood flow through thetissue surrounding the plurality of second surgical fasteners afterformation is less than blood flow through the tissue surrounding theplurality of third surgical fasteners after formation.

In one embodiment, the third backspan of the plurality of third surgicalfasteners may be substantially linear in configuration. Alternatively,the third backspan may have a twisted configuration which is preferablysimilar to the twisted backspan of the second fasteners, except defininga third height that is less than the second height defined by the secondbackspan of the plurality of second surgical fasteners or alternativelyhave an inwardly directed curve defining a third height less than secondheight.

In an alternative embodiment, the plurality of first surgical fastenersinclude first legs extending from the first backspan and terminating inpenetrating ends, as well as at least one curve that is formed in thefirst backspan, wherein the at least one curve extends towards thepenetrating ends and is dimensioned to define a first height.Additionally, or alternatively, the plurality of second surgicalfasteners may include second legs extending from the second backspan andterminating in penetrating ends, as well as at least one curve that isformed in the second backspan, wherein the at least one curve extendstowards the penetrating ends and is dimensioned to define a secondheight that is less than the first height.

In another aspect of the present disclosure, a surgical fastenercartridge is provided including a plurality of surgical fastenersdisposed therein. The plurality of surgical fasteners include aplurality of first surgical fasteners arranged in a first row and havinga first backspan with a first configuration, and a plurality of secondsurgical fasteners arranged in a second row and having a second backspanwith a second configuration. The first backspan has a first height andthe second backspan has a second height, the first height being lessthan the second height.

In one embodiment, the first and second backspans have a twistedconfiguration and the first fastener applies a first compressive forceto tissue upon formation, and the second surgical fasteners apply asecond, lesser compressive force to tissue upon formation.

In one embodiment, the first surgical fasteners include first legsextending from the first backspan and terminating in penetrating endsand the second surgical fasteners include second legs extending from thesecond backspan and terminating in penetrating ends, wherein the firstbackspan includes at least one portion curving inwardly toward thepenetrating ends of the first legs to form a humped configuration anddimensioned to define a first height, and the second backspan includesat least one portion curving inwardly toward the penetrating ends of thesecond legs to form a humped configuration and dimensioned to define asecond height different from the first height.

In preferred embodiments, the plurality of first fasteners define a pairof first rows and the plurality of second surgical fasteners define apair of second rows disposed further from the central longitudinal axisof the cartridge than the pair of first rows.

The cartridge may include a plurality of third surgical fasteners havinga third backspan with a third configuration such that the plurality ofthird surgical fasteners apply a third compressive force to the tissueupon formation that is different from at least one of the firstcompressive force and the second compressive force respectively appliedto the tissue by the plurality of first surgical fasteners and theplurality of second surgical fasteners upon formation, the thirdfasteners being disposed further from the central longitudinal axis ofthe pair of first TOWS.

These and other features of the surgical fastener applying apparatus,surgical fastener cartridge, and surgical fasteners disclosed hereinwill become more readily apparent to those skilled in the art throughreference to the detailed description of various embodiments of thepresent disclosure that follows.

BRIEF DESCRIPTION OF THE DRAWINGS

Various embodiments of the present disclosure are described herein, withreferences to the drawings, wherein:

FIG. 1 is a top, perspective view of a distal end portion of a surgicalfastener applying apparatus including a surgical fastener cartridge inaccordance with one embodiment of the present disclosure;

FIG. 2 is a side, perspective view of one embodiment of a surgicalfastener, including a substantially linear backspan and shown prior toformation, for use with the surgical fastener cartridge seen in FIG. 1;

FIG. 3 is a cross-sectional view of the surgical fastener shown in FIG.2 subsequent to formation within adjacent tissue segments;

FIG. 4 is a side, perspective view of an alternative embodiment of thesurgical fastener shown in FIG. 2 including a twisted backspan with aplurality of protrusions defining a first height;

FIG. 5 is a cross-sectional view of the surgical fastener shown in FIG.4 formed within adjacent tissue segments;

FIG. 6 is a side, perspective view of another alternative embodiment ofthe surgical fastener shown in FIG. 2 including a twisted backspan witha plurality of protrusions defining a second, greater height;

FIG. 7 is a cross-sectional view of the surgical fastener shown in FIG.6 formed within adjacent tissue segments;

FIG. 8 is an axial, cross-sectional view taken through line 8-8 in FIG.1, which illustrates the surgical fastener cartridge loaded with thesurgical fasteners seen in FIGS. 2-5, wherein the surgical fastenersshown in FIGS. 4, 5 are arranged in a pair of inner rows and thesurgical fasteners shown in FIGS. 2, 3 are arranged in a pair of outerrows;

FIG. 9 is a partial, longitudinal, perspective view, with parts removed,of the surgical fastener cartridge seen in FIG. 8 illustrating theplurality of surgical fasteners arranged into inner and outer rows;

FIG. 10 is a partial, longitudinal, cross-sectional view of the surgicalfastener cartridge of seen in FIG. 8 taken through line 10-10 in FIG. 1,which illustrates an inner and outer row of surgical fasteners;

FIG. 11 is a top, perspective view of an alternative embodiment of thesurgical fastener cartridge seen in FIG. 1 loaded with a plurality ofsurgical fasteners arranged into inner rows, intermediate rows, andouter rows;

FIG. 12 is an axial, cross-sectional view taken through line 12-12 inFIG. 11, which illustrates the surgical fastener cartridge loaded withthe surgical fasteners seen in FIGS. 2-7, wherein the surgical fastenersshown in FIGS. 6, 7 are arranged in the inner rows, the surgicalfasteners shown in FIGS. 4, 5 are arranged in the intermediate rows, andthe surgical fasteners shown in FIGS. 2, 3 are arranged in the outerrows;

FIG. 13 is a partial, longitudinal, perspective view, with partsremoved, of the surgical fastener cartridge seen in FIG. 12 illustratingthe plurality of surgical fasteners arranged into inner, intermediate,and outer rows;

FIG. 14 is a partial longitudinal, cross-sectional view of the surgicalfastener cartridge of FIG. 12 taken through line 14-14 in FIG. 11, whichillustrates an inner, intermediate, and outer row of surgical fasteners;

FIG. 15 illustrates an exemplary surgical fastener applying apparatusfor use with the surgical fastener cartridge seen in FIG. 1 during alaparoscopic surgical procedure;

FIG. 16 is a partial, perspective view of a tool assembly of thesurgical fastener applying apparatus seen in FIG. 15, with partsseparated, illustrating an anvil and the surgical fastener cartridge ofFIG. 1;

FIG. 17 illustrates an end-to-end anastomosis device for use with analternative embodiment of the surgical fastener cartridge seen in FIG. 1during a surgical anastomosis procedure;

FIG. 18 illustrates a surgical fastener applying instrument for use withyet another alternative embodiment of the surgical fastener cartridgeseen in FIG. 1 during an open gastrointestinal anastomotic fasteningprocedure;

FIG. 19 illustrates a transverse anastomosis fastener applyinginstrument for use with an alternative embodiment of the surgicalfastener cartridge shown in FIG. 18;

FIG. 20 is a top, perspective view of another alternative embodiment ofthe surgical fastener cartridge seen in FIG. 1 according to theprinciples of the present disclosure;

FIG. 21 is a side, perspective view of an alternative embodiment of thesurgical fastener shown in FIG. 2 including a backspan with a pluralityof recesses forming projections and defining a first height;

FIG. 22 is a cross-sectional view of the surgical fastener shown FIG. 21formed within adjacent tissue segments;

FIG. 23 is a side, perspective view of another alternative embodiment ofthe surgical fastener shown in FIG. 2 including a backspan with aplurality of recesses forming projections defining a second, greaterheight;

FIG. 24 is a cross-sectional view of the surgical fastener shown in FIG.23 formed within adjacent tissue segments;

FIG. 25 is a partial longitudinal, perspective view with parts removedof the surgical fastener cartridge seen in FIG. 8 loaded with aplurality of the surgical fasteners illustrated in FIGS. 2 and 21,wherein the surgical fasteners shown in FIG. 21 are arranged in a pairof inner rows and the surgical fasteners shown in FIG. 2 are arranged ina pair of outer rows;

FIG. 26 is a partial longitudinal, cross-sectional view of the surgicalfastener cartridge shown in FIG. 25 taken through line 10-10 in FIG. 1,which illustrates an inner and outer row of surgical fasteners;

FIG. 27 is a partial top, perspective view of the surgical fastenercartridge seen in FIG. 11 when loaded with a plurality of the surgicalfasteners illustrated in FIGS. 2, 21, and 23, wherein the surgicalfasteners shown in FIG. 23 are arranged in a pair of inner rows, thesurgical fasteners shown in FIG. 21 are arranged in a pair ofintermediate rows, and the surgical fasteners shown in FIG. 2 arearranged in a pair of outer rows; and

FIG. 28 is a partial longitudinal, cross-sectional view of the surgicalfastener cartridge shown in FIG. 27 taken through line 14-14 in FIG. 11,which illustrates an inner, intermediate, and outer row of surgicalfasteners.

DETAILED DESCRIPTION OF EXEMPLARY EMBODIMENTS

Various exemplary embodiments of the presently disclosed surgicalfastener applying apparatus, surgical fastener cartridge, and surgicalfasteners will now be described in detail with reference to the drawingswherein like references characters identify similar or identicalelements. In the drawings, and in the description which follows, theterm “proximal” will refer to the end of the surgical fastener applyingapparatus that is closer to the clinician during use, while the term“distal” will refer to the end that is further from the clinician, as istraditional and conventional in the art. In addition, the term “surgicalfastener” should be understood to include any substantially rigidstructure that is suitable for the intended purpose of joining tissuetogether, including but not being limited to surgical staples, clips,and the like.

FIG. 1 illustrates a distal end portion of an exemplary surgicalfastener applying apparatus 1000 including a surgical fastener cartridge100 in accordance with the principles of the present disclosure. Thesurgical fastener cartridge 100 extends along a longitudinal axis “A-A,”and includes a cartridge body 112 with a pair of side walls 114, 116, abottom wall 118, and a top wall 120. The top wall 120 includes a knifeslot or channel 122 that is configured to accommodate longitudinalmovement of a knife member 123 (FIG. 16) or other cutting element suchthat tissue may be severed along a cut-line. The top wall 120 furtherincludes a tissue engaging surface 124 for maintaining the position ofthe tissue to be cut, and a plurality of fastener retention slots 126that are arranged into a plurality of rows 128 that extend along thelength (longitudinal axis) of the surgical fastener cartridge 100. Asshown in FIG. 1, the fastener retention slots 126 are arranged into apair of first (inner) rows 128 _(A) that are spaced laterally outwardfrom the channel or knife slot 122, on opposite sides thereof, and apair of second (outer) rows 128 _(B) that are spaced laterally outwardfrom the pair of first rows 128 _(A), again on opposite sides of theslot 122. While the surgical fastener cartridge 100 is depicted asincluding pairs of first and second rows 128 _(A), 128 _(B),respectively, additional rows of fastener retention slots 126 (andfasteners) may be included in alternative embodiments of the surgicalfastener cartridge 100, as discussed below. In various embodiments ofthe present disclosure, it is envisioned that the surgical fastenercartridge 100 may be removable, or replaceable, with another loadedsurgical fastener cartridge.

Each of the fastener retention slots 126 is configured to receive one ofa plurality of surgical fasteners, e.g., the surgical fasteners andpushers 129 (FIG. 8) such that the surgical fasteners are deployed inrows, e.g. inner and outer rows in the embodiment shown in FIG. 1, onopposite sides of the cut-line created in the tissue during the surgicalfastening procedure.

Further details regarding the fastener cartridge 100 may be obtainedthrough reference to U.S. Pat. No. 7,070,083, the entire contents ofwhich are incorporated herein by reference.

Referring now to FIGS. 2 and 3 as well, the surgical fastener cartridge100 is loaded with one or more varieties of surgical fastener, one ofwhich may be the surgical fastener 130. The surgical fastener 130includes two legs 132 extending from a backspan 134 extendingtherebetween. The thickness of the backspan 134 and the legs 132 can bevaried such that the surgical fastener 130 may be used to fastenadjacent tissue segments “T₁,” “T₂” of any thickness.

The legs 132 and the backspan 134 may define a cross-section having anysuitable geometric configuration, including but not being limited torectangular, oval, square, triangular, trapezoidal, etc. The legs 132and the backspan 134 may exhibit the same geometrical configuration suchthat the cross-sectional configuration of the surgical fastener 130 issubstantially uniform, as shown in FIGS. 2, 3, or alternatively, thelegs 132 and the backspan 134 may exhibit different geometricalconfigurations, e.g., the legs 132 may exhibit a rectangularcross-sectional configuration whereas the backspan 134 may exhibit anoval cross-sectional configuration.

Prior to formation of the surgical fastener 130, the legs 132 extendfrom the backspan 134 such that they are substantially parallel.Alternatively, the legs 132 may converge or diverge from the backspanforming an acute or obtuse angle with the backspan. Each of the legs 132terminates in a penetrating end 136 that is configured to penetratetissue, e.g., tissue segments “T₁,” “T₂” (FIG. 3). The penetrating ends136 of legs 132 can be tapered to facilitate the penetration of thetissue segments “T₁,” “T₂,” or alternatively, the penetrating ends 136may not include a taper. In various embodiments of the surgical fastener130, it is also envisioned that the penetrating ends 136 mayalternatively define either conical or flat surfaces, as described inco-pending U.S. application Ser. No. 11/444,761, filed Apr. 13, 2003,the entire contents of which are incorporated herein by reference. Thesurgical fastener 130 may also be configured as a directionally biasedstaple, such as that described in commonly owned U.S. Pat. No.7,398,907, the entire contents of which are incorporated herein byreference.

In the embodiment of the surgical fastener 130 illustrated in FIGS. 2and 3, the backspan 134 is substantially linear in configuration. Whenformed within tissue, e.g., within the tissue segments “T₁,” “T₂” (FIG.3), the legs 132 of the surgical fastener 130 cooperate with thebackspan 134 to maintain adjacent the tissue segments “T₁,” “T₂” inapproximation and apply a compressive force “F” thereto. The compressiveforce “F” applies pressure to the tissue segments “T₁,” “T₂,” therebyrestricting the flow of blood through the tissue surrounding thesurgical fastener 130 and facilitating hemostasis. The linearconfiguration of the backspan 134 limits the amount of pressure that canbe applied to the tissue segments “T₁,” “T₂,” however, such that theflow of blood through the tissue is not completely restricted. Whenformed, the surgical fastener 130 forms a substantially “B” shapedconfiguration and defines an overall height “H_(F),” measured from thebackspan 134 to the outermost curve of the formed legs 132.

FIGS. 4-7 illustrate alternative configurations for the surgicalfastener 130 shown in FIG. 2 that will be identified generally by thereference characters 130 _(A) (FIGS. 4, 5) and 130 _(B) (FIGS. 6, 7).The surgical fastener 130 _(A) includes a non-linear twisted backspan134 _(A) defining one or more projections 138 _(A), and the surgicalfastener 130 _(B) includes a non-linear twisted backspan 134 _(B)defining one or more projections 138 _(B), such that the backspans 134_(A), 134 _(B) are substantially non-linear in configuration. Thesurgical fastener backspans 134 _(A) and 134 _(B) differ inconfiguration in that they have different heights as described in moredetail below. When formed, the substantially non-linear configuration ofthe twisted backspans 134 _(A), 134 _(B) further restricts the flow ofblood through the tissue surrounding the surgical fasteners 134 _(A),134 _(B) upon formation when compared to the substantially linearbackspan 134 of the surgical fastener 130 (FIG. 2).

Referring now to FIGS. 4, 5 in particular, the backspan 134 _(A) of thesurgical fastener 130 _(A) includes two projections 138 _(A) defined bythe twisted configuration thereof. It should be appreciated thatalthough the backspan has a twist that defines two projections 138 _(A),it is also contemplated that further twists could be provided to defineadditional projections 138 _(A). The projections 138 _(A) extendoutwardly from the backspan 134 _(A) towards the penetrating ends 136_(A) of the legs 132 _(A), and define a first height “H₁” that ismeasured from the top of the projection 138 _(A) to the outermost curveof the backspan 134 _(A). When the surgical fastener 130 _(A) is formedwithin the tissue segments “T₁,” “T₂,” the projections 138 _(A)cooperate with the legs 132 _(A) of the surgical fastener 130 _(A) toapply a compressive force “F_(A)” thereto. The compressive force “F_(A)”applied by the surgical fastener 130 _(A) is greater than thecompressive force “F” applied by surgical fastener 130 (FIG. 3), as thecompressive space 140 _(A) defined between the backspan 134 _(A) and thelegs 132 _(A) and occupied by the tissue segments “T₁,” “T₂” is less inthe surgical fastener 130 _(A) when compared to the compressive space140 (FIG. 3) occupied by the tissue segments “T₁,” “T₂” upon formationof the surgical fastener 130. Accordingly, when compared to the surgicalfastener 130, the surgical fastener 130 _(A) applies greater pressure tothe tissue segments “T₁,” “T₂.” Consequently, the flow of blood throughthe tissue surrounding the surgical fastener 130 _(A) upon formationwill be more restricted when compared to the flow of blood through thetissue surrounding surgical fastener 130 upon formation, thereby furtherfacilitating hemostasis. The dimensions of the projections 138 _(A) andthe compressive space 140 _(A) occupied by the tissue segments “T₁,”“T₂” are such that blood flow is not completely restricted, however,thereby preventing against any unnecessary necrosing of tissue. Whenformed, the surgical fastener 130 _(A) defines an overall height “H_(F)”(measured from the backspan 134 _(A) to the outermost curve of theformed legs 132 _(A)) that is substantially equal to that defined by thesurgical fastener 130 (FIG. 3).

Referring now to FIGS. 6, 7, the backspan 134 _(B) of the surgicalfastener 130 _(B) includes two projections 138 _(B) defined by thetwisted configuration thereof. It should be appreciated that althoughthe backspan 134 _(B) has a twist that defines two projections 138 _(B),it is also contemplated that further twists could be provided to defineadditional projections 138 _(B). The projections 138 _(B) extendoutwardly from the backspan 134 _(B) towards the penetrating ends 136_(B) of the legs 132 _(B) to define a second height “H₂” that is greaterthan the height “H₁” of the projections 134 _(A) extending outwardlyfrom the backspan 134 _(A) of surgical fastener 130 _(A) illustrated inFIGS. 4, 5. Accordingly, when the surgical fastener 130 _(B) is formedwithin tissue segments “T₁,” “T₂” (FIG. 7), the projections 138 _(B)cooperate with the legs 132 _(B) of the surgical fastener 130 _(B) toapply a compressive force “F_(B)” thereto that is greater than thecompressive forces “F” (FIG. 3), “F_(A)” (FIG. 5) respectively appliedby the surgical fasteners 130, 130 _(A), as the compressive space 140_(B) (FIG. 7) occupied by the tissue segments “T₁,” “T₂” upon formationof the surgical fastener 130 _(B) is less than the compressive spaces140 (FIG. 3) and 140 _(A) (FIG. 5) respectively occupied by the tissuesegments “T₁,” “T₂” upon formation of the surgical fasteners 130, 130_(A). Accordingly, when compared to the surgical fasteners 130, 130_(A), the surgical fastener 130 _(B) applies greater pressure to thetissue segments “T₁,” “T₂.” Consequently, the flow of blood through thetissue surrounding the surgical fastener 130 _(B) upon formation will bemore restricted when compared to the flow of blood through the tissuesurrounding surgical fasteners 130, 130 _(A) upon formation. Thedimensions of the projections 138 _(B) and the compressive space 140_(B) occupied by the tissue segments “T₁,” “T₂” are such that blood flowis substantially, if not completely restricted, thereby furtherfacilitating, and effectuating hemostasis. When formed, the surgicalfastener 130 _(B) defines an overall height “H_(F)” that issubstantially equal to those defined by the surgical fasteners 130 (FIG.3), 130 _(A) (FIG. 5).

The surgical fasteners 130 _(A), 130 _(B) shown in FIGS. 4-7 aresubstantially similar but for the dimensions of the one or moreprojections 138 _(A), 138 _(B), formed in their respective backspans 134_(A), 134 _(B). The respective dimensions “H₁,” “H₂” of the projections138 _(A), 138 _(B) as well as the dimensions of the compressive spaces140 _(A), 140 _(B) occupied by tissue segments “T₁,” “T₂” when therespective surgical fasteners 130 _(A), 130 _(B) are formed, may bealtered or varied in different embodiments to effectuate any desiredlevel of hemostasis and blood flow in the tissue segments “T₁,” “T₂”dependent upon the attributes of the tissue, e.g., the thicknessthereof, or the presence of scar tissue.

FIGS. 8-10 illustrate the surgical fasteners 130, 130 _(A) installedwithin the cartridge body 112 shown in FIG. 1. The surgical fasteners130, 130 _(A) are arranged within the cartridge body 112 to define apair of first (inner) rows 142 _(A) and a pair of second (outer) rows142 _(B) that correspond to the respective inner and outer rows 128_(A), 128 _(B) of fastener retention slots 126 formed in the top wall120 (FIG. 1). Accordingly, the pair of inner rows 142 _(A) are spacedlaterally from the knife slot 122, on opposite sides thereof, and thepair of outer rows 142 _(B) are spaced laterally from the pair of innerrows 142 _(A) (further away from the central longitudinal axis of thecartridge), again on opposite sides of the knife slot 122. As such, thesurgical fasteners 130, 130 _(A) will be deployed on opposite sides ofthe cut-line (not shown) created in the tissue upon fastening. That is,the surgical fasteners 130 _(A), which include the aforedescribedprojections 138 _(A) (FIGS. 4, 5), provide a greater compressive forceto the tissue, since there is a shorter distance between the projections138 _(A) and the curve of the formed legs 132, and accordingly, areprovided in the inner rows 142 _(A) closer to the cut-line. Thefasteners 130, which define a greater distance between the curve of thelegs 132 and the backspan 134 upon formation, are provided in the outerrows 142 _(B), where the tissue might be thicker as a result of clampingthe jaws of the surgical fastener applying apparatus 1000 (FIG. 1).

By positioning the fasteners providing greater tissue compression closerto the cut-line, i.e., the surgical fasteners 130 _(A) in the embodimentof the surgical fastener cartridge 100 illustrated in FIGS. 8-10, agreater range of tissue thicknesses can be effectively sealed by asingle cartridge. It should be appreciated however, that the presentdisclosure also envisions that the surgical fasteners can be positionedotherwise without departing from the scope of the present disclosure.Also, while the inner and outer rows 142 _(A), 142 _(B) are shown asincluding the surgical fasteners 130 _(A), 130, respectively, thepresent disclosure contemplates the use of any of the surgical fasteners130 (FIGS. 2, 3), 130 _(A) (FIGS. 4, 5), 130 _(B) (FIGS. 6, 7) disclosedherein, either exclusively, such that only a single type surgicalfastener, e.g., surgical fastener 130, is present in a particular row,or in combination, such that a variety of surgical fasteners, e.g.,surgical fasteners 130 and 130 _(A), are present in the row.

As seen in FIGS. 11-14, in one embodiment, the disclosed surgicalfastener cartridge 100 includes a top wall 120 having a plurality offastener retention slots 126 arranged into a pair of first (inner) rows128 _(A) that are spaced laterally outward from the knife slot 122, apair of second (intermediate) rows 128 _(B) that are spaced laterallyoutward from the pair of inner rows 128 _(A), and a pair of third(outer) rows 128 _(C) that are spaced laterally outward (further fromthe central longitudinal axis) from the pair of intermediate rows 128_(B), each of which is spaced on opposite sides of the knife slot 122.In this embodiment, the fasteners, e.g., the surgical fasteners 130(FIGS. 2, 3), 130 _(A) (FIGS. 4, 5), 130 _(B) (FIGS. 6, 7) arerespectively arranged within the cartridge body 112 to define a pair offirst (inner) rows 142 _(A), a pair of second (intermediate) rows 142_(B), and a pair of third (outer) rows 142 _(C) that correspond to therespective inner, intermediate, and outer rows 128 _(A), 128 _(B), 128_(C) of fastener retention slots 126 formed in the top wall 120 ofsurgical fastener cartridge 100. As with the embodiment of the surgicalfastener cartridge 100 seen in FIGS. 1 and 8-10, each of the respectiveinner, intermediate, and outer rows 142 _(A), 142 _(B), 142 _(C) maycomprise any of the surgical fasteners 130, 130 _(A), 130 _(B) disclosedherein, either exclusively, such that only a single surgical fastener,e.g., surgical fastener 130, is present in a particular row, or incombination, such that a variety of surgical fasteners, e.g., surgicalfasteners 130, 130 _(A), and 130 _(B), are present.

As illustrated in FIGS. 12-14, in one particular embodiment, the outerrows 142 _(C), the intermediate rows 142 _(B), and the inner rows 142_(A) are comprised solely of the surgical fasteners 130, 130 _(A), 130_(B), respectively, such that the flow of blood through the tissueimmediately surrounding the cut-line is more restricted by the inner row142 _(A) of surgical fasteners 130 _(B), whereas the flow of bloodthrough the tissue surrounding the respective intermediate and outerrows 142 _(B), 142 _(C) is less restricted by surgical fasteners 130_(A), 130. Accordingly, the flow of blood will be minimized through thetissue immediately adjacent the cut-line, and will be increasedgradually with the lateral distance from the cut-line. Also, by thisarrangement, the surgical fasteners with the largest projections, e.g.,the surgical fasteners 130 _(B), will be positioned closest to thecut-line where the tissue is generally compressed to a greater extent,and the surgical fasteners providing for less compression, e.g., thesurgical fasteners 130, which include a substantially linear backspan134, will be positioned further from the cut-line where the tissue isgenerally compressed to a lesser extent. It is also contemplated thatinstead of a row of fasteners 130 with a linear backspan, a row offasteners with a twisted backspan with a smaller height than the othertwisted backspan fasteners can be utilized on the outer rows.

With reference now to FIGS. 1, 15, and 16, the surgical fastenerapplying apparatus 1000 will be discussed. The surgical fastenerapplying apparatus 1000 may be of either the re-usable or disposablevariety, and includes a handle assembly 1002, with a movable handle 1003_(A) and a stationary handle 1003 _(B), that is operatively connected toa tool assembly 1004 through a distally extending elongated shaft orendoscopic portion 1006. In various embodiments, the handle assembly1002 may be manually operated, and either additionally or alternatively,may include motorized, hydraulic, ratcheting, or other such mechanisms.In general, the tool assembly 1004 is adapted to clamp, fasten together,and sever adjacent tissue segments along a cut-line.

The tool assembly 1004 includes a second jaw 1008 that is pivotallycoupled to a first jaw 1010 to facilitate approximation thereof. Thesecond jaw 1008 of the tool assembly 1004 includes an anvil 1100, andthe first jaw 1010 includes a surgical fastener cartridge assembly 1200incorporating the aforedescribed surgical fastener cartridge 100 (FIG.1), which is loaded with a plurality of surgical fasteners, e.g., thesurgical fasteners 130 (FIGS. 2, 3), the surgical fastener 130 _(A)(FIGS. 4, 5), and/or the surgical fastener 130 _(B) (FIGS. 6, 7), (FIGS.2, 3). Pivoting the movable handle 1003 _(A) towards the stationaryhandle 1003 _(B) (FIG. 1) approximates the second jaw 1008 and the firstjaw 1010. After the jaws 1008, 1010 are in close operative alignmentclamping tissue therebetween, continued pivoting of the movable handle1003 _(A) ejects the plurality of surgical fasteners 100 (FIG. 3) fromthe surgical fastener cartridge 100 such that the surgical fasteners130, 130 _(A), 130 _(B) are driven into the anvil 1100, thus beingformed into formed surgical fasteners. The tool assembly 1004 and/or thesurgical fastener cartridge assembly 1200 may comprise a removable andreplaceable loading unit for the surgical fastener applying apparatus1000.

As mentioned earlier, the surgical fastener applying apparatus 1000includes the knife member 123. As seen in FIG. 16, the knife member 123is operatively connected to a drive beam 1012, as described in commonlyassigned U.S. Pat. No. 7,398,908, currently assigned to Tyco HealthcareGroup LP, the contents of which are hereby incorporated by referenceherein in its entirety. The knife member 123 may be configured anddimensioned for simultaneous engagement with both the anvil member 1100and a cavity 1202 that is defined by the first jaw 1010.

During use, the tool assembly 1004 (FIG. 15) is first actuated to clamponto tissue by manipulating the movable handle 1003 _(A) to advance acontrol rod (not shown) distally. Distal advancement of the control rodresults in corresponding movement of the knife member 123 (FIG. 16), andeffectuates approximation of the anvil member 1100 and the surgicalfastener cartridge assembly 1200. With tissue clamped between the anvilmember 1100 and the surgical fastener cartridge assembly 1200, thefasteners, e.g., the surgical fastener 130 (FIGS. 2, 3), the surgicalfastener 130 _(A) (FIGS. 4, 5), and/or the surgical fastener 130 _(B)(FIGS. 6, 7), are fired from the surgical fastener applying apparatus1000 (FIG. 1) into the tissue. The movable handle 1003 _(A) is thenoperated again to further advance the knife member 123 (FIG. 16).

Referring now to FIGS. 1-16, a method of fastening tissue with thesurgical fastener applying apparatus 1000 (FIG. 1) will be discussed.During use, the surgical fastener applying apparatus 1000 isapproximated and fired similarly to, and in accordance with other knownsurgical fastener applying apparatus, such as that disclosed in commonlyassigned U.S. Pat. No. 5,865,361, currently assigned to Tyco HealthcareGroup LP, the contents of which are hereby incorporated by referenceherein in its entirety.

The movable handle 1003 _(A) (FIG. 15) is operatively connected to anactuation shaft, which receives the proximal end of a control rod, suchthat manipulation of the movable handle 1003 _(A) results in linearadvancement of the actuation shaft, which causes corresponding linearadvancement of the control rod. An axial drive assembly is also providedthat is engagable with the control rod. More specifically, the axialdrive assembly includes the elongated drive beam 1012 (FIG. 16), whichincludes a distal end that supports the knife member 123, and a drivemember that is configured and dimensioned for engagement with thecontrol rod. As seen in FIG. 16, the knife member 123 is positioned totranslate behind a sled 1204.

After the surgical fastener applying apparatus 1000 (FIG. 15) ismanipulated to position the target tissue between the open jaws 1008,1010 of the tool assembly 1004, the jaws 1008, 1010 are approximatedusing the handle assembly 1002 to clamp the target tissue therebetweenand apply a compressive force thereto. Specifically, manipulation of themovable handle 1003 _(A) advances the actuation shaft to effectuatecorresponding advancement of the control rod. Since the control rod isconnected at its distal end to the drive assembly, which includes theaforementioned drive beam 1012 (FIG. 16), distal movement of the controlrod causes corresponding movement of the drive beam 1012, which in turn,forces the anvil 1100 towards the surgical fastener cartridge assembly1200.

With the tissue securely clamped between the jaws 1008, 1010 (FIG. 1),the surgical fastener applying apparatus 1000 is then fired to eject thesurgical fasteners, e.g., the surgical fasteners, e.g., the surgicalfastener 130 (FIGS. 2, 3), the surgical fastener 130 _(A) (FIGS. 4, 5),and/or the surgical fastener 130 _(B) (FIGS. 6, 7). To fire the surgicalfastener applying apparatus 1000 (FIG. 15), the movable handle 1003 _(A)is again manipulated to cause advancement of the drive assembly, whichcauses the sled 1204 (FIG. 16) to traverse the cartridge body 1202, andeject the plurality of surgical fasteners 130, 130 _(A), 130 _(B) fromthe surgical fastener cartridge 100 (FIG. 1). More specifically, as thesled 1204 moves distally, it engages the pushers 129 (FIGS. 8, 12, 16)to thereby drive the surgical fasteners 130, 130 _(A), 130 _(B)upwardly, i.e., towards the top wall 120 (FIG. 1) of the surgicalfastener cartridge 100. As the surgical fasteners 130, 130 _(A), 130_(B) are driven upwardly, the fastener retention slots 126 maintain therelative positions thereof.

After passing through the fastener retention slots 126, the surgicalfasteners 130, 130 _(A), 130 _(B) pass through the tissue and are forcedinto engagement with pockets 1102 formed in a tissue contacting surface1104 of the anvil 1100, thereby achieving, for example, the formedconfigurations seen in FIGS. 3, 5, and 7, respectively. Upon formationwithin the tissue, the surgical fasteners 130, 130 _(A), 130 _(B) limitthe blood flow through the tissue immediately adjacent and surroundingthe cut-line to thereby effectuate hemostasis, while permitting greaterblood flow through the tissue spaced laterally therefrom to minimizingnecrosing of the tissue, as discussed above.

While the tool cartridge has been discussed in connection with thesurgical fastener applying apparatus 1000, which is adapted for use inlaparoscopic procedures for performing surgical anastomotic fastening oftissue, the cartridge may be adapted for use with any surgicalinstrument suitable for the intended purpose of applying the pluralityof surgical fasteners, e.g., the surgical fasteners 130, 130 _(A), 130_(B), to a section of tissue, and thereafter, severing the tissue alonga cut-line.

For example, the tool assembly 1004 (FIG. 1) may be adapted for use withan end-to-end anastomosis apparatus 2000 (FIG. 17), such as thatdisclosed in commonly assigned U.S. Pat. No. 7,455,676, currentlyassigned to Tyco Healthcare Group LP, the contents of which are herebyincorporated by reference herein in its entirety. The apparatus 2000 isused to simultaneously deploy a plurality of surgical fasteners arrangedin substantially annular rows. A knife is advanced with the firing ofthe fasteners. The apparatus 200 includes a handle assembly 2002 havinga pair of actuating handle members 2004 and an approximation knob (wingnut) for moving (retracting) anvil 2016 toward cartridge 2012 containingthe surgical fasteners. Cartridge 2012 is at the distal end of tubularbody portion 2008 which extends from handle assembly 2002. An anvilshaft 2014 operatively couples anvil 2016 to the handle assembly 2002such that the anvil 2016 is repositionable from a location where it isin close cooperative alignment with the fastener cartridge 2012 to alocation where it is spaced apart from the fastener staple cartridge2012.

The tool assembly 2010 includes a fastener ejection member that ispositioned within the fastener cartridge 2012. The fastener ejectionmember includes a distal portion defining concentric rings ofperipherally spaced staple pushers that are received within a respectivestaple retention slot to eject the surgical fasteners from the fastenercartridge 2012. The fastener ejection member is configured anddimensioned to be contacted by a distal end of a driver tube that isoperatively connected to handle members 2004 through the body portion2008 such that manipulation effectuates advancement of the driver tubeto force the staple pushers into engagement with the plurality ofsurgical fasteners retained with in the fastener cartridge 2012 to causeejection of the fasteners through tissue and into contact with the anvilpockets of the anvil 2016, providing varying compressive forces on thetissue due to the varying configurations of the fastener.

The tool assembly 1004 (FIG. 1) may also be adapted for use with asurgical stapling apparatus 3000 (FIG. 18), such as that disclosed incommonly assigned U.S. Pat. No. 7,334,717, the contents of which arehereby incorporated by reference herein in its entirety. The surgicalstapling apparatus 3000 includes a cartridge receiving half-section3002, which accommodates a plurality of surgical fasteners arranged in aplurality of substantially linear rows, and an anvil half-section 3004containing a plurality of anvil pockets arranged in corresponding rows.The half-sections 3002, 3004 are pivotally connected via handles 3006,3008 for approximation during use.

Following approximation of the half-sections 3002, 3004 to clamp tissuetherebetween, the surgical fastener applying apparatus 3000 is fired byadvancing firing mechanism 3010 distally by the advancement of a firingknob 3012. Distal movement of the firing mechanism 3010 causes aplurality of cam bars to engage camming surfaces that interact with aplurality of pushers to expel the plurality of surgical fasteners fromthe cartridge receiving half-section 3002 through tissue into contactwith the anvil pockets of the anvil portion 3004, providing varyingcompressive forces on the tissue due to the varying configurations ofthe fasteners. The surgical fasteners are positioned on either side of atrack which guides a knife during longitudinal movement to thereby severtissue along a cut-line.

The tool assembly 1004 (FIG. 1) may also be adapted for use with atransverse anastomosis fastening instrument 4000 (FIG. 19), such as thatdisclosed in commonly owned U.S. Pat. Nos. 5,964,394 and 7,070,083, thecontents of which are hereby incorporated by reference herein in theirentirety. The surgical fastener applying apparatus 4000 includes anapproximation lever 4001, a movable handle 4002, and an elongatedportion 4004 that extends distally from the handle 4002. The cartridge200, containing a plurality of fasteners arranged in substantiallylinear rows transverse to a longitudinal axis of the instrument, issupported within cartridge receiving portion 4014 of frame 4006.

Prior to firing of the surgical fastener applying apparatus 4000, theapproximation lever 4001 is actuated to distally advance a drive memberthat is operatively connected to the surgical fastener cartridge 200 tomove the surgical fastener cartridge 200 towards the anvil 4012, whichremains stationary, and capture tissue therebetween. Thereafter, thehandle 4002 is moved to advance a pusher bar distally through theelongated portion 4004 to cause corresponding movement of a head portionincluded at the distal end of the pusher bar. The head portion includesa plurality of fingers extending distally therefrom that are configuredand dimensioned to engage the cartridge assembly to thereby eject theplurality of surgical fasteners retained therein through tissue and intocontact with the anvil pockets of anvil 4012 for formation, providingvarying compressive forces on the tissue due to the varying diameters. Aknife can be provided in the apparatus.

It is also envisioned that the tool assembly 1006 (FIG. 1) may also beadapted for use with any of the other surgical fastener applyingapparatus discussed in commonly owned U.S. Pat. Nos. 6,045,560;5,964,394; 5,894,979; 5,878,937; 5,915,616; 5,836,503; 5,865,361;5,862,972; 5,817,109; 5,797,538; and 5,782,396, the disclosures of whichare hereby incorporated by reference herein in their entirety.

In additional embodiments of the present disclosure, the surgicalfastener applying apparatus may include a plurality of cam bars forinteracting with the pushers to deploy the surgical fasteners. Forexample, the surgical fastener applying apparatus disclosed in U.S. Pat.No. 5,318,221, the disclosure of which is hereby incorporated byreference herein, in its entirety, has a cam bar adapter that holds aplurality of cam bars and a knife. A channel is advanced throughoperation of the handle of the apparatus, which drives the cam bars andknife forward. A clamp tube that surrounds the proximal end of the anvilis advanced to clamp the anvil and cartridge together. In anotherexample, the surgical fastener applying apparatus disclosed in U.S. Pat.No. 5,782,396, the disclosure of which is hereby incorporated byreference herein, in its entirety, has an actuation sled. An elongateddrive beam is advanced distally through operation of the handle of theapparatus, driving the actuation sled forward. The distal end of thedrive beam engages the anvil and the channel that supports the cartridgeas the drive beam travels distally, to deploy the staples and clamp theanvil and cartridge together.

Referring now to FIG. 20, an alternative embodiment of the surgicalfastener cartridge, identified generally by the reference character 200,will be discussed. The surgical fastener cartridge 200 is substantiallysimilar to the surgical fastener cartridge 100 discussed above, andaccordingly, will only be discussed with respect to its differencestherefrom.

The surgical fastener cartridge 200 is loaded with a plurality ofsurgical fasteners that are arranged into one or more rows, as in thecase of the aforedescribed surgical fastener cartridge 100. However, incontrast to the surgical fastener cartridge 100, the surgical fastenercartridge 200 does not include a knife slot for the accommodation of aknife or other such cutting element, although an alternative embodimentincluding a knife slot would be within the scope of the presentdisclosure. The surgical fastener cartridge 200 includes a plurality offastener retention slots 226 on a top wall 220 of a cartridge body 212that are arranged into a plurality of rows 228. The rows 228 ofretention slots 226 are spaced laterally from a centerline 252 extendingalong the longitudinal axis “A-A” defined by cartridge body 212, and maybe positioned equidistant from the sidewalls 214, 216. As shown, theplurality of rows 228 includes a pair of first (inner) rows 228 _(A)that are disposed on opposite sides of the centerline 252, and a pair ofsecond (outer) rows 228 _(B) that are spaced laterally outward from thepair of inner rows 228 _(A), (further from the central longitudinal axisof the cartridge), again on opposite sides of the centerline 252. Eachof the fastener retention slots 226 is configured and dimensioned toreceive one of a plurality of surgical fasteners, e.g., the surgicalfasteners 130 (FIGS. 2, 3), 130 _(A) (FIGS. 4, 5), or 130 _(B) (FIGS. 6,7) and pushers 129 (FIG. 8) therein such that the surgical fasteners aredeployed in rows, e.g., inner and outer rows in the embodiment of thesurgical fastener cartridge 200 shown of FIG. 20, on opposite sides ofthe centerline 252.

Although the surgical fastener cartridge 200 is depicted as includingpairs of first and second rows 228 _(A), 228 _(B), respectively,additional rows of fastener retention slots 226, and accordingly,additional rows of surgical fasteners, may be included in alternativeembodiments of the surgical fastener cartridge 200, as discussed abovewith respect to surgical fastener cartridge 100. Also, it is envisionedthat the fasteners may be arranged within the surgical fastenercartridge 200 in any of the various exemplary configurations discussedabove with respect to the surgical fastener cartridge 100, for example.

Reference will now be made to FIGS. 21-24, which illustrate alternativeconfigurations for the surgical fastener 130 shown in FIG. 2 that willbe identified generally by the reference characters 130 _(C) (FIGS. 21,22) and 130 _(D) (FIGS. 23, 24), that may be loaded into the surgicalfastener cartridge 100 shown in FIGS. 1, 8, for example and used withthe various apparatus described herein. The surgical fastener 130 _(C)includes a non-linear backspan 134 _(C) with one or more recesses 138_(C) formed therein. The recesses 138 _(C) form curved portionsextending inwardly from the backspan 134 _(C), i.e., towards thepenetrating ends 136 _(C) in the unformed condition, in arcuate fashionto define one or more humps having a first height “H₁” that act torestrict the flow of blood through the tissue surrounding the surgicalfastener 130 _(C). As shown, in the formed condition of the fastener,the backspan preferably has a first curved portion opposite the curve ofone of the legs and a second curved portion opposite the curve of theother fastener leg.

When the surgical fastener 130 _(C) is formed within tissue segments“T₁,” “T₂,” as seen in FIG. 22 for example, the curves (humps) 138 _(C)cooperate with the legs 132 of the surgical fastener 130 _(C) to apply acompressive force “F_(C)” thereto. The compressive force “F_(C)” appliedby the surgical fastener 130 _(C) is greater than the compressive force“F” applied by surgical fastener 130 (FIG. 3), as the compressive space140 _(C), which is defined between the backspan 134 _(C) and the legs132 _(C) and occupied by the tissue segments “T₁,” “T₂,” is less in thesurgical fastener 130 _(C) when compared to the compressive space 140(FIG. 3) occupied by the tissue segments “T₁,” “T₂” in the surgicalfastener 130. Accordingly, greater pressure is applied to the tissuesegments “T₁,” “T₂” by surgical fastener 130 _(C). Consequently, theflow of blood through the tissue surrounding the surgical fastener 130_(C) is more restricted when compared to the flow of blood through thetissue surrounding surgical fastener 130 (FIG. 3), thereby furtherfacilitating hemostasis. The dimensions of the recesses/curves 138 _(C)and the compressive space 140 _(C) occupied by the tissue segments “T₁,”“T₂” are such that blood flow is not completely restricted, however,thereby preventing any unnecessary necrosing of tissue. When formed, thesurgical fastener 130 _(C) defines an overall height “H_(F)” (measuredfrom the backspan 134 _(C) to the outermost curved of the formed legs132 _(C)) that is substantially equal to that defined by the surgicalfastener 130 (FIG. 3).

With particular reference to FIGS. 23 and 24, an alternative embodimentof the surgical fastener, identified generally by the referencecharacter 130, is shown in its formed condition. The surgical fastener130 _(D) is similar to the surgical fastener 130 _(C) discussed abovewith respect to FIGS. 21 and 22, in that the surgical fastener 130 _(D)includes a pair of recesses/curves 138 _(D) formed in the backspan 134_(D) defining a pair of humps or curves. However, the recesses/curves138 _(D) formed in the backspan 134 _(D) of the surgical fastener 130_(D) define a height “H₂” that is greater than the height “H₁” of thehumps or recesses 138 _(C) formed in the backspan 134 _(C) of thesurgical fastener 130 _(C) illustrated in FIGS. 21 and 22. Accordingly,when the surgical fastener 130 _(D) is formed within tissue segments“T₁,” “T₂,” the recesses/curves 138 _(D) cooperate with the legs 132_(D) of the surgical fastener 130 _(D) to apply a compressive force“F_(D)” thereto. The compressive force “F_(D)” applied by the surgicalfastener 130 _(D) is greater than the compressive forces “F,” “F_(C)”respectively applied by the surgical fasteners 130 (FIG. 2, 3), 130 _(C)(FIGS. 21, 22), as the compressive space 140 _(D) occupied by the tissuesegments “T₁,” “T₂” is less in the surgical fastener 130 _(D) whencompared to the compressive spaces 140 (FIG. 3), 140 _(C) (FIG. 22)respectively occupied by the tissue segments “T₁,” “T₂” in the surgicalfasteners 130, 130 _(C). Accordingly, greater pressure is applied to thetissue segments “T₁,” “T₂” by the surgical fastener 130. Consequently,the flow of blood through the tissue surrounding the surgical fastener130 _(D) is more restricted when compared to the flow of blood throughthe tissue surrounding surgical fasteners 130 (FIG. 3), 130 _(C) (FIGS.21, 22). The dimensions of the recesses/curves 138 _(D) and thecompressive space 140 _(D) occupied by the tissue segments “T₁,” “T₂”are such that blood flow is substantially, if not completely restricted,thereby further facilitating, and effectuating hemostasis. When formed,the surgical fastener 130 _(D) defines an overall height “H_(F)” that issubstantially equal to those defined by the surgical fasteners 130 (FIG.3), 130 _(C) (FIG. 22).

The surgical fasteners 130 _(C) (FIG. 21, 22), 130 _(D) (FIGS. 23, 24)are substantially similar in configuration but for the dimensions of thehump(s) (curves) formed by the recesses 138 _(C), 138 _(D) formed intheir respective backspans 134 _(C), 134. The respective dimensions“H₁,” “H₂” of the recesses/curves 138 _(C), 138, as well as thedimensions of the compressive spaces 140 _(C), 140 _(D) occupied bytissue segments “T₁,” “T₂” when the respective surgical fasteners 130_(C), 130 _(D) are in their formed conditions, may be altered or variedin different embodiments to effectuate a desired level of hemostasis andblood flow in the tissue segments “T₁,” “T₂” dependent upon variousattributes of the tissue, e.g., thickness or the presence of scartissue.

FIGS. 25 and 26 illustrate the surgical fasteners 130 (FIG. 3) and 130_(C) (FIGS. 21, 22) installed within the cartridge body 112 seen inFIG. 1. The surgical fasteners 130 _(C), 130 are arranged within thecartridge body 112 to define a pair of first (inner) rows 142 _(A) and apair of second (outer) rows 142 _(B) that correspond to the respectiveinner and outer rows 128 _(A), 128 _(B) of fastener retention slots 126formed in the top wall 120 (FIG. 1). Accordingly, the pair of inner rows142 _(A) is spaced laterally outward from the knife slot 122, onopposite sides thereof, and the pair of outer rows 142 _(B) are spacedlaterally outward from the pair of inner rows 14 _(2A), again onopposite sides of the knife slot 122 and further from a centrallongitudinal axis of the cartridge. As such, the surgical fasteners 130,130 _(C) will be deployed on opposite sides of the cut-line (not shown)created in the tissue upon fastening. That is, the surgical fasteners130 _(C), which include the aforedescribed projections or curves 138_(C) (FIGS. 20, 21), provide a greater compressive force to the tissue,since there is a shorter distance between the projections 138 _(C) andthe curve of the formed legs 132, and accordingly, are provided in theinner rows 142 _(A) closer to the cut-line. The fasteners 130, whichdefine a greater distance between the curve of the legs 132 and thebackspan 134 upon formation, are provided in the outer rows 142 _(B),where the tissue might be thicker as a result of clamping the jaws ofthe apparatus, e.g. the surgical fastener applying apparatus 1000 (FIG.1).

By positioning the fasteners providing greater tissue compression closerto the cut-line, i.e., the surgical fasteners 130 _(C) in the embodimentof the surgical fastener cartridge 100 illustrated in FIGS. 24 and 25, agreater range of tissue thicknesses can be effectively sealed by asingle surgical fastener cartridge. It should be appreciated however,that the present disclosure also envisions that the surgical fastenerscan be positioned otherwise without departing from the scope of thepresent disclosure. Also, while the inner and outer rows 142 _(A), 142_(B) are shown as including the surgical fasteners 130 _(C), 130,respectively, the present disclosure contemplates the use of any of thesurgical fasteners 130 (FIGS. 2, 3), 130 _(A) (FIGS. 4, 5), 130 _(B)(FIGS. 6, 7), 130 _(C) (FIGS. 20, 21), 130 _(C) (FIGS. 22, 23) disclosedherein above, either exclusively, such that only a single type surgicalfastener, e.g., surgical fastener 130, is present in a particular row,or in combination, such that a variety of surgical fasteners, e.g.,surgical fasteners 130 and 130 _(C), are present.

FIGS. 27 and 28 illustrate another embodiment of the present disclosurein which the cartridge body 112, shown in FIG. 1, may be loaded with thesurgical fasteners 130 (FIG. 3), 130 _(C) (FIGS. 21, 22), and 130 _(D)(FIGS. 23, 24). In this embodiment, as with the embodiment seen in FIGS.1 and 11-14 and discussed above, the disclosed surgical fastenercartridge 100 includes a top wall 120 having a plurality of fastenerretention slots 126 arranged into a pair of first (inner) rows that arespaced laterally from the knife slot 122, a pair of second(intermediate) rows that are spaced laterally from the pair of innerrows, and a pair of third (outer) rows that are spaced laterally fromthe pair of intermediate rows, each of which is spaced on opposite sidesof the knife slot 122. Accordingly, the fasteners, e.g., surgicalfasteners 130, 130 _(C), 130 _(D) are arranged within the cartridge body112 to define a pair of first (inner) rows 142 _(A), a pair of second(intermediate) rows 142 _(B), and a pair of third (outer) rows 142 _(C)that correspond to the respective inner, intermediate, and outer rows128 _(A), 128 _(B), 128 _(C) of fastener retention slots 126 formed inthe top wall 120 of surgical fastener cartridge 100. In this embodiment,as with the embodiment of FIGS. 1 and 11-14, each of the respectiveinner, intermediate, and outer rows 142 _(A), 142 _(B), 142 _(C) maycomprise any of the surgical fasteners 130, 130 _(C), 130 _(D) disclosedherein, either exclusively, such that only a single type surgicalfastener, e.g., surgical fastener 130, is present in a particular row,or in combination, such that a variety of surgical fasteners, e.g.,surgical fasteners 130, 130 _(C), and 130 _(D), are present. In theparticular embodiment shown in FIGS. 27 and 28, however, the respectiveouter, intermediate, and inner rows 142 _(C), 142 _(B), and 142 _(A) arecomprised solely of the surgical fasteners 130, 130 _(C), 130 _(B), suchthat the flow of blood through the tissue immediately surrounding thecut-line is more restricted by the inner row 142 _(A) of surgicalfasteners 130, whereas the flow of blood through the tissue surroundingthe respective intermediate and outer rows 142 _(B), 142 _(C),respectively, is less restricted by the surgical fasteners 130 _(C),130, respectively. Accordingly, the flow of blood will be minimized inthe tissue immediately adjacent the cut-line, and will be increasedgradually with the lateral distance from the cut-line. Also, by thisarrangement, the surgical fasteners with the largest curvedportions/recesses, e.g., the surgical fasteners 130, will be positionedclosest to the cut-line where the tissue is generally compressed to agreater extent, and the surgical fasteners providing for lesscompression, e.g., the surgical fasteners 130, which include asubstantially linear backspan 134, as described above, will bepositioned further from the cut-line where the tissue is generallycompressed to a lesser extent.

The above description, disclosure, and figures should not be construedas limiting, but merely as exemplary of particular embodiments. It is tobe understood, therefore, that the disclosure is not limited to theprecise embodiments described, and that various other changes andmodifications may be effected by one skilled in the art withoutdeparting from the scope or spirit of the disclosure. Additionally,those skilled in the art will appreciate that the elements and featuresillustrated or described in connection with one embodiment can becombined with those of another, and that such modifications andvariations are also intended to be included within the scope of thepresent disclosure.

1. A tool assembly for use with a surgical fastener applying apparatus, the tool assembly comprising: a first jaw including a cartridge assembly having a plurality of surgical fasteners disposed therein, each surgical fastener in the plurality of surgical fasteners including a pair of legs terminating in penetrating ends, and a backspan connecting the pair of legs having a twisted configuration such that a face of the backspan is rotated along a length of the backspan.
 2. The tool assembly of claim 1, wherein the cartridge assembly includes a plurality of first surgical fasteners disposed therein, and a plurality of second surgical fasteners disposed therein, each of the plurality of first surgical fasteners including a first backspan having a twisted configuration such that a face of the first backspan is rotated along at least a portion of the length of the first backspan, and each of the plurality of second surgical fasteners including a second backspan having a twisted configuration such that a face of the second backspan is rotated along at least a portion of the length of the second backspan, the dimensions of the first backspan being different than the dimensions of the second backspan.
 3. The tool assembly of claim 2, wherein the first backspan defines a first height, and the second backspan defines a second height different than the first height such that the plurality of first surgical fasteners apply a first compressive force to tissue upon formation, and the plurality of second surgical fasteners apply a second, different compressive force to tissue upon formation.
 4. The tool assembly of claim 1, wherein the face of the backspan is rotated uniformly along at least a portion of the length of the backspan.
 5. The tool assembly of claim 2, wherein the plurality of first surgical fasteners and the plurality of second surgical fasteners are dimensioned such that the second height is greater than the first height, whereby the second compressive force is greater than the first compressive force.
 6. The tool assembly of claim 5, wherein the plurality of first surgical fasteners are arranged in a first row, and the plurality of second surgical fasteners are arranged in a second row spaced apart from the first row.
 7. The tool assembly of claim 6, wherein the cartridge assembly includes a channel configured to accommodate a cutting member for the creation of a cut-line in the tissue.
 8. The tool assembly of claim 7, wherein the first row of surgical fasteners is positioned a first distance from the channel, and the second row is positioned a second, greater distance from the channel.
 9. The tool assembly of claim 8, further comprising a plurality of third surgical fasteners, each of the surgical fasteners in the plurality of third surgical fasteners including a third backspan having a twisted configuration such that a face of the third backspan is rotated along a length of the third backspan, the dimensions of the third backspan being different than the dimensions of at least one of the first backspan and the second backspan.
 10. The tool assembly of claim 9, wherein the third backspan defines a third height different than at least one of the first height and the second height such that the plurality of third surgical fasteners apply a third compressive force to tissue upon formation different than at least one of the first compressive force and the second compressive force.
 11. The tool assembly of claim 10, wherein the plurality of third surgical fasteners define an overall height when formed that is substantially equivalent to the overall height defined by the plurality of first surgical fasteners and the plurality of second surgical fasteners when formed.
 12. The tool assembly of claim 11, wherein the plurality of third surgical fasteners are dimensioned such that the third height is greater than the second height, whereby the third compressive force is greater than the second compressive force.
 13. The tool assembly of claim 1, wherein the face of the backspan is rotated along the entire length of the backspan.
 14. The tool assembly of claim 1, wherein the backspan includes multiple twists such that at least two portions of the backspan extend toward the penetrating ends of the legs.
 15. A surgical fastener for use in a medical procedure, the surgical fastener including a pair of legs terminating in penetrating ends configured to pass through tissue, and a backspan connecting the pair of legs having a face oriented in different directions along a length of the backspan such that the backspan defines a non-uniform tissue contacting surface.
 16. The surgical fastener of claim 15, wherein the backspan is rotated uniformly along the length of the backspan.
 17. A surgical fastener applying apparatus comprising: a handle portion; an elongate body portion extending distally from the handle portion; and a tool assembly supported adjacent a distal end of the elongate body portion, the tool assembly including: a first jaw including an anvil assembly; and a second jaw pivotally coupled to the first jaw such that the tool assembly is repositionable to clamp tissue between the first jaw and the second jaw, the second jaw including a cartridge assembly having a plurality of surgical fasteners disposed therein, each surgical fastener in the plurality of surgical fasteners including a pair of legs terminating in penetrating ends, and a backspan connecting the pair of legs having a face oriented in different directions along a length of the backspan such that the backspan defines a non-linear tissue contacting surface.
 18. The surgical fastener applying apparatus of claim 17, wherein the backspan of each surgical fastener in the plurality of surgical fasteners includes multiple twists such that at least two portions of the backspan extend toward the penetrating ends of the legs.
 19. The surgical fastener applying apparatus of claim 17, wherein the cartridge assembly includes a plurality of first surgical fasteners disposed therein, and a plurality of second surgical fasteners disposed therein, each of the surgical fasteners in the plurality of first surgical fasteners including a first backspan having a first face oriented in different directions along a length of the first backspan such that the first backspan defines a first non-linear tissue contacting surface, and each of the surgical fasteners in the plurality of second surgical fasteners including a second backspan having a second face oriented in different directions along a length of the second backspan such that the second backspan defines a second non-linear tissue contacting surface twisted, the dimensions of the first backspan being different than the dimensions of the second backspan.
 20. The surgical fastener applying apparatus of claim 19, wherein the first backspan defines a first height, and the second backspan defines a second height different than the first height such that the plurality of first surgical fasteners apply a first compressive force to tissue upon formation, and the plurality of second surgical fasteners apply a second, different compressive force to tissue upon formation. 